title: Is proton pump inhibitor therapy for reflux esophagitis sufficient?: a large real-world survey of Japanese patients.
abstract: OBJECTIVE
  Proton pump inhibitors (PPIs) are widely used as the mainstay of treatment for erosive reflux esophagitis, based on the excellent results obtained in clinical trials. However, the endoscopic remission rates in patients treated with PPIs in actual clinical settings have not been fully assessed. We conducted a nationwide survey to evaluate the effectiveness of PPIs based on endoscopic findings in real-world clinical settings.
  
  
  METHODS
  This was a multicenter retrospective study conducted among 41 Japanese institutions. Endoscopic findings before and after PPI therapy were collected from the medical records of patients diagnosed with Los Angeles grade A-D reflux esophagitis who had been treated with a PPI for at least eight weeks before undergoing a second endoscopy. The remission rates of erosive esophagitis, defined as the percentage of patients with grade N or M findings following PPI therapy, were calculated.
  
  
  RESULTS
  Data for 541 patients were analyzed. At first endoscopy, 45.5%, 30.3%, 15.9% and 8.3% of patients were diagnosed with grade A, B, C and D esophagitis, respectively. The mean duration of PPI therapy was 410 days, and the mean remission rate was 61.6%. The remission rate was significantly lower in the patients with more severe erosive esophagitis based on the LA grade before PPI therapy.
  
  
  CONCLUSIONS
  This study revealed that approximately 40% of the patients did not achieve remission of erosive esophagitis following PPI therapy for a mean of 1.1 years. This suggests the necessity of providing careful follow-up using periodic endoscopy and appropriately selecting PPI therapy.
authors.affiliation: Second Department of Internal Medicine, Osaka Medical College, Japan. higuchi@poh.osaka-med.ac.jp
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Higuchi
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
authors.forename: Koji
authors.initials: K
authors.lastname: Nakada
authors.forename: Ken
authors.initials: K
authors.lastname: Haruma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000208:ethnology*; D003625:Data Collection / Q000379:methods; D004942:Esophagitis, Peptic / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors